Research from Mass General Clinicians Highlights the Growing Opioid Problem and Its Impact on Health Outcomes

The opioid epidemic continues to devastate the United States, with drug overdose deaths and opioid-related health complications on the rise. According to the CDC, from 2000 to 2015 more than half a million people died from drug overdoses, and 91 Americans die every day from an opioid overdose.

91 Americans die every day from an opioid overdose.

The introduction of initiatives such as needle exchange programs and Narcan trainings provide hope for curbing infection and overdose rates. But what happens to opioid users who still require hospitalization? New research from Massachusetts General Hospital provides a new glimpse into the health outcomes for opioid-related hospitalizations.

Spike in opioid-related deaths during hospital stays

Between 1993 and 2014, four times as many patients died from opioid-related causes in the hospital, rising from 0.43 percent to 2.02 percent.

Opioid-driven deaths during hospital stays in the United States quadrupled between 1993 and 2014, according to a recent study published in Health Affairs.

Lead author Zirui Song, MD, PhD, a physician at Mass General, analyzed nearly 385,000 hospital stays involving patients who were admitted for opioid use. Song found that by 2014, four times as many patients were dying from opioid-related causes in the hospital, rising from 0.43 percent before 2000 to 2.02 percent.

The rate of opioid-driven hospitalizations remained relatively stable, but patients were increasingly likely to be hospitalized for deadlier conditions such as opioid poisoning. Before 2000, most hospitalizations were for opioid dependence and abuse.

The average age for patients admitted to the hospital for opioid use was 39 years old, highlighting how opioid addiction can strike while patients are still in the prime of life.

The majority of patients were also white. From 1993 to 2014, the number of black and Hispanic patients admitted to hospitals for opioid or heroin poisoning remained relatively stable.

However, that rate among white patients doubled between 2007 and 2013. With about 30,000 cases, they were the “largest and fastest-growing share of hospitalizations” in recent years, according to the Health Affairs article.

While the data alone can’t explain why more people are dying with opioids in their system after being admitted to the hospital, Song suggests it may be due in part to the rise of fentanyl, which is much stronger and cheaper than heroin or prescription opioids.

Additionally, efforts to treat people where they are — in the field, or at clinics or urgent care facilities — could mean that hospitals tend to admit patients who “are higher risk and more severe,” he said.

Song said the study is intended to raise awareness of the need for better strategies for hospitals when patients are admitted for using opioids, in addition to continuing and improving public health and community strategies already underway.

Rise of infections in the emergency room

As the number of opioid-related deaths continue to grow, clinicians are also seeing increased numbers of opioid-related infections, which often lead to dire complications.

When a patient comes to the emergency department (ED) seeking care for an infection resulting from injecting highly addictive opioids like heroin, fentanyl and oxycodone, emergency radiologists are often the first to diagnose complications, using X-rays, MRIs, CT scans and ultrasounds to spot an infection.

“Radiology is central to patient care in the Emergency Department setting. We need to be actively advocating for these patients and giving them an opportunity to take steps into recovery.”

Infections often occur at the injection site, either from bacteria mixed in the drug, on a dirty needle or on dirty skin through which the needle passes. The bacteria can also grow in the bloodstream and accumulate and grow into either the heart valves, or branch out to the lungs, brain and spine, where they continue to grow and cause chronic, debilitating diseases which can require multiple surgeries and long-term care. The data proves that these diseases and associated complications can also be fatal.

Looking at the data of more than 1,000 substance abuse patients who sought care for opioid injection-related infections between 2005 and 2016, Mass General radiologists Efren Flores, MD, and Renata R. Almeida, MD, MSc, found a dramatic increase in patients coming into EDs with complications associated with injecting opioids.

The research team found that 121 of the 1,031 patients, or nearly 12 percent, died before the end of the study period. The mortality rate was 14 percent for patients with a positive imaging diagnosis of substance-abuse-related complications – significantly higher than the 10 percent rate for patients with no such history.

These results were presented at the Radiological Society of North America (RSNA) 2017 Annual Meeting in a session called “Radiology in the Midst of the Opioid Epidemic”.

Two-thirds of patients in the study were men. Similar to patients in Song’s research, 78 percent were white and the average age was 36 years old.

Both research studies highlight the severity of the opioid epidemic and how everyone in healthcare has a role to play in helping patients with their illness.

“Radiology is central to patient care in the Emergency Department setting,” said Flores during RSNA 2017. “We need to be actively advocating for these patients and giving them an opportunity to take steps into recovery.”

“These results are just scratching the surface of what health professionals and policymakers could use to help patients and the public,” said Song, “and the picture they paint is concerning.”